Provider Demographics
NPI:1982826194
Name:WETHERBEE-MCDEVITT, ELLEN (PT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:WETHERBEE-MCDEVITT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:WETHERBEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 349
Mailing Address - Street 2:14 WOOSTER RD.
Mailing Address - City:TARIFFVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06081-0349
Mailing Address - Country:US
Mailing Address - Phone:860-768-5314
Mailing Address - Fax:860-768-4558
Practice Address - Street 1:200 BLOOMFIELD AVE
Practice Address - Street 2:DANA 410
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-1545
Practice Address - Country:US
Practice Address - Phone:860-768-5314
Practice Address - Fax:860-768-4558
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004139225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist